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NEUROLOGY NEWS: Multiple Sclerosis and Smoking Risk

Neurology Now

May/June 2009

Volume 5(3)

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PATUREL, AMY M.S., M.P.H.

NEUROBIC ANSWERS FROM P. 9:1: An apple a day keeps the doctor away; 2: Silence is golden; 3: A picture is worth a thousand words; 4: I'm all ears; 5: Too many chefs spoil the broth; 6: Not my cup of tea; 7: What goes up must come down; 8: Bring home the bacon; 9: Look before you leap.

We've known for decades about the non-neurologic risk for smoking—heart disease, lung disease, cancer, says Barbara S. Giesser, M.D., clinical director of the MS program at the University of California in Los Angeles. “Now we have evidence that it may adversely affect the course of MS.” And while scientists don't know exactly how smoking promotes the onset and progression of disease, the detrimental effects are indisputable.

Research shows that smokers have a 40- to 80-percent higher risk of developing MS than non-smokers. “The more you smoke, the greater the risk,” says Alberto Ascherio, M.D., professor of epidemiology and nutrition at Harvard School of Public Health and associate professor of medicine at Harvard Medical School.

But smoking doesn't only affect the onset of MS; it also impacts the progression of the disease. Smokers are twice as likely to develop full MS from a clinically isolated event (a one-time episode of tingling or numbness) than nonsmokers. And research from Harvard School of Public Health shows that smokers are three times more likely to change from a relapsing/remitting course of MS to a secondary progressive course compared to people who never smoked.

Perhaps the most interesting research linking smoking and MS came from a 2007 study in the journal Brain that explicitly links the onset of MS before the age of 16 to childhood exposure to secondhand smoke. The longer the child was exposed to secondhand smoke, the more likely they were to develop MS. In the study, 62 percent of the 129 MS patients had been exposed to their parents' secondhand cigarette smoke during childhood compared to only 45.1 percent of healthy children.

Nevertheless, there's some controversy about whether smoking later in life increases the chances of developing MS. One study published in the Journal of Clinical Epidemiology found that the chances of getting MS among early smokers (between the ages of 11 and 45) is nearly three times higher than the chances of getting MS among smokers who started smoking after age 45.

“People who start smoking at younger ages tend to smoke for a longer period of time and smoke more,” says Dr. Ascherio. “But that doesn't mean that smoking at a later age doesn't increase the risk of MS. Smoking is associated with a higher risk of MS, regardless of when you start.”